The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis
Giovanni Palladini, Alessandra Barassi, Catherine Klersy, Rosana Pacciolla, Paolo Milani, Gabriele Sarais, Stefano Perlini, Riccardo Albertini, Paola Russo, Andrea Foli, Letizia Zenone Bragotti, Laura Obici, Remigio Moratti, Gian Vico Melzi d'Eril, Giampaolo Merlini, Giovanni Palladini, Alessandra Barassi, Catherine Klersy, Rosana Pacciolla, Paolo Milani, Gabriele Sarais, Stefano Perlini, Riccardo Albertini, Paola Russo, Andrea Foli, Letizia Zenone Bragotti, Laura Obici, Remigio Moratti, Gian Vico Melzi d'Eril, Giampaolo Merlini
Abstract
In light-chain (AL) amyloidosis, prognosis is dictated by cardiac dysfunction. N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn) are used to assess the severity of cardiac damage. We evaluated the prognostic relevance of a high-sensitivity (hs) cTnT assay, NT-proBNP, and cardiac troponin I in 171 consecutive patients with AL amyloidosis at presentation and 6 months after treatment. Response and progression of NT-proBNP were defined as more than 30% and more than 300 ng/L changes. All 3 markers predicted survival, but the best multivariable model included hs-cTnT. The hs-cTnT prognostic cutoff was 77 ng/L (median survival 10.6 months for patients with hs-cTnT above the cutoff). After treatment, response and progression of NT-proBNP and a more than 75% increase of hs-cTnT were independent prognostic determinant. In AL amyloidosis, hs-cTnT is the best baseline prognostic marker. Therapy should be aimed at preventing progression of cardiac biomarkers, whereas NT-proBNP response confers an additional survival benefit.
Source: PubMed